| NPI | 1518092683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CO 42270) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CO DR.0042270) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2023-05-23 |